The Essentials of a National System for 
Rehabilitation of Disabled Service 
Men of the American Forces 


By Douglas C. McMurtrie 








































The Essentials of a National System for 
Rehabilitation of Disabled Service 
Men of the American Forces 


A Statement Presented to the Committee 
on Education of the House of 
Representatives, March 31,1920 


By Douglas C. McMurtrie 

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Greenwich, Connecticut 
The Arbor Press 
1920 



COPYRIGHT, 1920, BY 
THE ARBOR PRESS 


Transfsrriri from. 

J } - i'oriao ? 3 Office 


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OCT: £ t920 

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The Essentials of a National System 
for Rehabilitation of Disabled Ser¬ 
vice Men of the American Forces 

What constitutes a sound system of 
rehabilitation for disabled soldiers? 
Fortunately, there is now a consider¬ 
able body of experience to draw upon 
for assistance in answering this ques¬ 
tion. 

At the time the United States 
entered the war the other belligerent 
nations had for several years been 
experimenting with methods of pro¬ 
vision for disabled men. The most 
obvious errors had been discovered 
and corrected, and the systems were 
becoming stabilized. 

The United States had, in addition 
to the experience at its disposal, time 
in which to prepare to discharge its 
responsibilities to disabled soldiers. 
Whereas the first disabled soldiers 
appeared on the streets of London and 
Paris two or three months after the 
outbreak of hostilities, a consequential 
number of our crippled soldiers did 
not come through the military hospi- 
[ 3 1 


tals to the stage when they would be 
ready for economic rehabilitation until 
two years after our declaration of war. 
So, in spite of the delay of 12 or 13 
months in giving the Federal Board 
for Vocational Education notice of its 
responsibility in this field, the time 
was still adequate for preparation. 

The temper of Congress was most 
generous in dealing with questions 
affecting disabled soldiers. All of the 
money asked for this cause (in one 
instance more than was requested) 
has been appropriated, and reason¬ 
able demands for legislative authority 
have been met. It was certainly the 
intention of Congress that the dis¬ 
abled American service man should 
be dealt with generously and capably. 

What, then, are the essential ele¬ 
ments in the plan of rehabilitation 
which should have been and, indeed, 
still should be worked out? 

1. The first requisite is sufficient 
money with which to do the job. 
There has been no handicap of a 
financial character in this country. 
The French, for example, saw many 

[4] 


rehabilitation features which they 
would have liked to carry through, 
but funds were not available. It is 
not enough to offer disabled soldiers 
training courses, for unless support for 
them and their families can be pro¬ 
vided they can not take advantage of 
the opportunities. For this main¬ 
tenance colossal appropriations are 
requisite, but they have been forth¬ 
coming. 

2. The second item is organization. 
It is patent that the disabled soldier 
in Wyoming should be dealt with in 
essentially the same way as his injured 
company mate from New Jersey. 
This requires national organization 
which must be directed from Washing¬ 
ton. But as the disabled man, after 
he is through with hospital treatment, 
wishes above all else to get back home 
the practical work must be done at a 
myriad of points throughout the 
country. The district system of 
organization is thus indicated, and the 
Federal board very wisely divided the 
country into 14 administrative dis¬ 
tricts. But in its method of admin- 
[5] 


istering those districts it was not so 
wise. 

It should be recalled that the prob¬ 
lem is one of human relation, personal 
and individual. Be there 40,000 or 
200,000 disabled soldiers with whom 
to deal, it may be safely averred that 
no two cases are alike. Each case 
calls for an original decision, which 
some persons or group of persons must 
make. This situation would call for 
the establishment of some general 
rules of practice and some general 
prohibitions, leaving considerable lati¬ 
tude of judgment to the representa¬ 
tive most closely in touch with the 
individual soldier. 

The central office must needs have 
statistics and records. It must also 
lay down rules and regulations. But 
the work must be done in the field and 
the data sent to Washington for record 
and possible criticism. It is better 
that a representative of the board 
should meet a disabled soldier in 
Butte, Mont., should study the case, 
should make a plan with the man, and 
actually start him in training and 
[ 6 ] 


then send a record of the case to 
Washington, than that the whole 
matter should be held up pending 
decision from the central office. Even 
if the judgment of the local represen¬ 
tative is correct but 90 per cent of the 
time, there is no guaranty that the 
sapience of the Washington office, 
which has never seen the soldier, will 
be greater. One thing is sure, referring 
all cases for decision to a central point 
means endless red tape and delay. 
Delegating the power of decision to 
the man who actually deals with the 
soldier is simple and direct as well as 
logical. 

It is an axiom of administration 
that responsibility and authority 
engender interest and enthusiasm. 
Put a job up to a man and the chances 
are he will do it well. Make him a 
rubber stamp or a routine clerk and 
you kill his spirit. Imagine the case 
of a vocational adviser who has en¬ 
tered the service of the Federal Board 
with a desire to do everything in his 
power to help disabled soldiers. Con¬ 
ceive that he has been working hard 
[7l 


on a particular case, that after careful 
study he has worked out a plan which 
he is sure will be successful. He has 
aroused the soldier’s ambitions and 
brought him into the right frame of 
mind to undertake a course of training. 

But the adviser has no authority to 
do a thing. He makes a recommenda¬ 
tion, which goes to Washington and 
does not return for some time. Mean¬ 
while his enthused soldier friend drops 
in to see when he can start. The 
adviser is embarrassed that he can not 
tell him. Finally the recommendation 
is returned disallowed, with a notation 
by some one who has never seen the 
soldier giving a reason which the 
adviser knows is silly. 

We can imagine what a damper will 
be put on the enthusiasm of the soldier 
and the spirit of his friend and adviser. 
With what energy can we picture the 
adviser following up and putting 
through the alternative course of 
training? And as the character aspect 
is so much more vital than the techni¬ 
cal we can conceive it better that the 
two individuals were left to work out 
[ 8 ] 


the plan they created and for which 
they were responsible. 

If local representatives were given 
authority to act, it is clear they should 
report their action in every case to the 
Washington office for record, for 
criticism, for possible review. But 
meantime something would be under 
way. And if the central office was 
snowed under and became months 
late in review of the cases no grievous 
injury would be done the disabled 
soldiers. 

With delegation of authority should 
go grant of funds. Each local office 
should have a fund to meet immediate 
requirements, making expenditures 
(governed, of course, by the regula¬ 
tions), obtaining vouchers, and for¬ 
warding these to Washington with a 
complete accounting, so that the local 
fund could be reimbursed. 

Such district organization makes it 
necessary for the director to train and 
imbue with correct principles for the 
work the 14 regional chiefs alone. 
These men would each deal with their 
representatives in the cities within 
[9] 


their districts. These latter would 
break in their assistants, and so on 
likewise down the line. 

Consider the organization of Red 
Cross home service, which must be 
considered one of the greatest achieve¬ 
ments of the American people during 
the war. Literally hundreds of 
thousands of cases of American sol¬ 
diers and their families were handled 
with dispatch, wisdom, and satisfac¬ 
tion. Yet never a single case was 
decided in Washington. The central 
office determined the principles of the 
work, laid down restrictions, audited 
accounts. Had the cases been re¬ 
ferred to Washington, there is no 
building large enough to house the 
force of clerks that would have been 
required. 

When the soldier’s relative came 
for assistance the case was studied, the 
decision reached, and action taken the 
same day. Mistakes? Possibly some. 
But there certainly was service 
prompt enough to .be of some use. 
And it was not hit or miss. The 
worker making the decision had been 
f io] 


trained by instructors from head¬ 
quarters; he or she was constantly 
guided by advice or rulings from the 
same source. 

When a home-service worker was 
crowded with work, two assistants 
were broken in. Later, these assis¬ 
tants trained others. With such a 
system a thousand cases or a million 
cases could be cared for with equal 
ease. And the Washington head¬ 
quarters were never unduly, rushed. 
The officials there always had time to 
consider the larger aspects of the 
work and to strive for further im¬ 
provement. 

3. The most vital factor of all is the 
caliber of personnel. In this any 
Government bureau is hampered by 
limitation of salary scale and civil 
service formalities. But as we look 
back to the beginning of the Federal 
Board’s work we recall the generosity 
with which service and facilities were 
offered it in the interest of the dis¬ 
abled soldier. The best men in the 
country would have given a share of 
their time to serve on boards or com- 

[ 11 ] 


mittees. Many would have given full¬ 
time service either at Washington or 
in the cities where they lived. No 
such willingness was availed of. So 
instead of having the “biggest” men 
in the communities throughout the 
country identified with its work the 
board was limited to men whom it 
could hire for salaries ranging from 
$2,000 to 14,000. 

In only one instance was any volun¬ 
teer advice or assistance accepted, 
namely, in the appointment at the 
suggestion of the National Tubercu¬ 
losis Association of an advisory com¬ 
mittee on tuberculosis cases. This 
committee worked faithfully but the 
Federal Board paid very little atten¬ 
tion to its recommendations. 

Volunteer work used to be regarded 
with disfavor but during the war it 
was demonstrated that it could be 
made efficient. In the best organiza¬ 
tions volunteer workers were “hired” 
and “discharged” on the same basis 
as paid employees. There was no 
subject in which such inten.se interest 
was demonstrated as the future of the 
[ 12 ] 


disabled soldier, and the Federal 
Board could have built up a splendid 
corps. 

Leaving the consideration of volun¬ 
teer service out of the question how¬ 
ever, there are two ways in which men 
may be employed. The one is to get 
a good man, give him his instructions, 
and then allow him free hand to do his 
work. Every good executive follows 
this method, checking the results very 
carefully, of course, and discharging 
the man if he fails, but not annoying 
him constantly with petty interfer¬ 
ence. The remuneration to a good 
man under such circumstances is part 
in salary, but part in the creative 
satisfaction which he takes in his 
work. The second way is to use a 
man as a clerk and give him no author¬ 
ity and no responsibility. No really 
worth while man will keep such a job 
at any salary, and those who can be 
obtained are such as work for salary 
alone. Yet it is the second policy 
which was adopted by the Federal 
Board and a number of competent 
men have resigned by reason of it. 

[13] 


Members of a rehabilitation staff 
should be selected from varied lines. 
Particularly should those with experi¬ 
ence in social work—which is only 
another name for character and per¬ 
sonal problem work—be sought. The 
Federal Board has restricted its re¬ 
cruiting too largely to teachers. 

Another requirement is that dis¬ 
trict representatives be themselves 
residents of and familiar with the 
territories they are to cover. The 
average New Yorker would, for 
example, feel lost in the Northwest, 
and a Yankee is certainly not the one 
to send to New Orleans to deal there 
with both whites and negroes. The 
local staffs can best be locally re¬ 
cruited. 

The failure to use women in the 
contact work with soldiers was a great 
mistake. Leaving out of considera¬ 
tion the principle involved, it is a 
fact that for a given salary there can 
be employed a higher type of woman 
than man. And women are peculiarly 
apt for a human job of this kind. 

Inasmuch as the task of the Federal 
[ 14 ] 


Board is to meet a character problem 
much more than a vocational problem, 
the question of personnel is of the 
most vital importance. 

4. The next consideration is method 
of work. The most important factor 
is that the attitude toward the dis¬ 
abled soldier should be active rather 
than passive. Representatives of the 
board should seek out soldiers and an 
adviser should act in the capacity of 
attorney for an individual man to see 
that he gets the benefits that Congress 
intended him to have. Instead of 
taking the attitude of an insurance 
examiner who puts the burden of 
proof on the claimant there should 
rather be the spirit of the family 
lawyer who seeks diligently for the 
missing nephew in order to convey 
to him the estate bequeathed to him 
by an uncle. 

The work should all be done through 
personal contact. Letter writing is 
beyond many men who could very 
clearly tell their story verbally. And 
as half the job conferred upon the 
Federal Board was selling the proposi- 
[ 15 ] 


tion of rehabilitation, contact work 
in the field should have been regarded 
as a primary essential. The up-to- 
date business knows its prospective 
customers can be landed more surely 
by the personal call of a salesman than 
by mailing of printed matter. If the 
disabled soldier does not answer a 
notice he should be called on at his 
home, followed up if his address was 
changed, and brought into the fold. 

5. The next question concerns the 
place and manner of training, the 
principal difference of opinion being 
as to whether the disabled soldier 
should be sent to some regular trade 
school or to a special school for dis¬ 
abled men in general or for disabled 
soldiers. All the experience of our 
allies pointed to the necessity for 
special schools. The difficulties of 
depending upon existing educational 
facilities were: (a) There are prac¬ 
tically no trade schools for full-grown 
men; ( b ) an adult feels embarrassed 
attending an industrial school or busi¬ 
ness college with young boys and girls; 
(c) the teachers in regular schools are 
[ 16] 


not familiar with the special educa¬ 
tional difficulties involved with cases 
of physical handicap; ( d ) what the 
teachers do learn from mistakes and 
experience is not cumulative for the 
benefit of other disabled men, because 
the soldier pupils are too scattered; 
and (e) in a standard institution doing 
its regular work the individual atten¬ 
tion and constant mental bolstering 
and encouragement that an injured 
man requires can not be provided. 
In a special school the subjects of 
instruction, the staff, the methods, 
the hours, and regime are all planned 
for the special type of pupil. 

Although Canada, Great Britain, 
France, Belgium, and Italy had all 
found special schools for disabled 
soldiers to be necessary to successful 
work, the Federal Board, in its wis¬ 
dom, determined upon a course 
diametrically opposite. 

6 . Mechanism of rehabilitation calls 
next for consideration; so far as the 
soldier is concerned this comprises 
three stages: (a) Field work by 
“sleuths” who run down the disabled 
[ 17 ] 


men to put them in touch with their 
opportunities; (ft) personal advice 
regarding plans for the future, choice 
of training, etc., and (c) follow up 
during and after the course of training 
to see if the plan is working out as 
expected, to smooth over difficulties, 
and so far as possible to assure ulti¬ 
mate success in the return to civilian 
life. 

Promptness of action is of particular 
importance. A man can very quickly 
drift into habits of idleness or become 
discouraged and enter a blind-alley 
occupation. At the beginning of 
rehabilitation work in this country, 
the point most emphasized by ad¬ 
visers from abroad was that there 
should not be a week's delay in start¬ 
ing the disabled soldier on his way. 
Of course, the only way to attain 
speed is to decentralize authority, 
putting it locally in the hands of high- 
grade men. 

7. Yet overdoing the matter is to 
be avoided. The indiscriminate award 
of long courses where they are not 
required, the loose distribution of 
[ 18] 


Government money in maintenance 
allowances, may be prejudicial to the 
real interests of the disabled men. 
It is a great mistake, for example, to 
have men take easy courses a couple 
of years in length, for they become 
lazy and get into the habit of depend¬ 
ing on the Government for their 
support. In Canada, for example, 
they have taken great pains to prevent 
pauperization of the men. 

When the Federal Board has come 
under fire, its reaction has been to put 
cases through by the hundreds and to 
grant courses by the wholesale. 
What the disabled .soldiers needed 
instead was more personal attention. 
If high-grade effort were put on every 
case, the solution in many instances 
would be found without necessity for 
a long and expensive training course. 

8 . An essential in any successful 
system of rehabilitation is a strong 
and effective program of public educa¬ 
tion relative to the real needs of the 
disabled soldier, the right attitude 
toward him on the part of the public, 
the employer, hie family, etc. With 
[ 19 ] 


the generous cooperation offered by 
the newspapers, the magazine press, 
the moving-picture producers, etc., a 
splendid campaign would have been 
possible. But the Federal Board has 
accomplished almost nothing along 
this line. 

This memorandum has endeavored 
to set forth some of the features of a 
rehabilitation system which are of 
positive importance. What has been 
the success in other countries with 
the same work? 

It is true that all the countries have 
encountered difficulties, but many of 
them were due to the necessity for 
sailing an uncharted sea, with no 
previous experience to observe and 
follow. There is space for considera¬ 
tion of but one system, and that from 
the aspect of the disabled soldier. 

The injured British soldier is dis¬ 
charged from military hospital and 
goes at once to his own home. Before 
he gets his discharge he receives a card 
advising him to call on the local war 
pensions committee in his own town; 
that this body will‘look out for his 
[ 20 ] 


needs. When he gets home he goes 
to the office of the committee on a 
Tuesday, let us say, and meets the 
executive secretary, a paid officer 
placed in the job by the national 
pensions ministry. He is asked to 
come back Wednesday afternoon 
when the members of the committee 
will be meeting so that he can talk 
over with them his own situation. 
Meantime he may be asked to see the 
medical adviser of the committee so 
that there shall be ready a report on 
his physical condition. 

The committee is made up of some 
of the most useful members of the 
community, serving without pay. It 
comprises possibly a couple of manu¬ 
facturers, one educator, a minister, 
a labor representative, and surely a 
few women. The soldier talks over 
his case with the committee or with a 
delegated number of members. These 
members know the community, the 
industrial possibilities, the employers 
in the various lines. Doubtless one or 
more of them knows the soldier or his 
family. So they advise him and, at 
[ 21 ] 



once, if possible, determine upon the 
plan he is to pursue. His degree of 
disability under the regulations given 
them is decided, and the executive 
secretary is in a position that day to 
start paying him a pension. They 
award what is called an “interim” 
pension, which is reported to London, 
and which is subject to revision if 
headquarters objects. But mean¬ 
while the man is not left penniless. 

If training is determined upon as 
wise, the soldier can start the next 
day and, again, the local officer can 
start paying his tuition and the 
maintenance allowance for himself and 
dependents. The course decided 
upon, its length, and probable cost 
is reported to London, and, of course, 
the choice is guided by certain regula¬ 
tions issued to the local committees 
from time to time. As with the 
pension, London may, but seldom 
does, cut down the length of the 
course. But meantime the man has 
made a start. 

Individual members of the com¬ 
mittee make themselves responsible 
[ 22 ] 


for keeping in touch with a certain 
number of the soldiers, visiting their 
families, etc. This provides follow up 
of the best type. 

The payments mentioned are made 
from an “imprest” fund, reimbursed 
from London as expenditure vouchers 
are sent in. 

In large cities there are subcom¬ 
mittees covering different sections of 
the community. 

It is all very simple and direct; and 
though the working is not perfect, at 
least the soldier gets action, and is not 
put off, put off again, and finally 
disheartened. 

The point again to be emphasized, 
in conclusion, is that the problem of 
dealing with disabled soldiers is a 
human problem. It involves the 
establishment of confidence between 
two individuals, and the acquaintance 
with record, personality, and tempera¬ 
ment upon which can be based helpful 
advice for the future. The data of 
human problems can never be stand¬ 
ardized or reduced to forms to be read 
over and judged by distant officials. 
Some person must make a decision, 
and that person must be the one in 
actual touch with the soldier himself. 

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